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A few years ago, Dr. Ebo Kwabena Blankson noticed that more of his teenage patients were complaining of anxiety and sleep problems.

And then the pediatrician saw the cans.

More of the teens showing up for checkups at his adolescent clinic at the Naval Medical Center in Portsmouth, Va., were carrying cans of energy drinks.That’s when Blankson began to ask his patients how much of the stuff they regularly drank. Their answers led him to launch a study of what energy drinks were doing to their bodies.That study, published this month in the journal Pediatrics in Review, shows that the caffeine in energy drinks is particularly harmful to young children and to teenagers who mix them with alcohol. His research found that both caffeine use and withdrawal have been linked to headaches, heart arrhythmias and increased blood pressure in children and teenagers.

Caffeine from additives — such as guarana, a plant derivative — is not necessarily listed on the can, leaving health officials to estimate that energy drinks contain 200 to 250 milligrams of caffeine.An 8-ounce cup of coffee typically contains 150 milligrams of caffeine; a 20-ounce Coke, more than 50 milligrams.Regular doses of caffeine — even as small as 80 to 100 milligrams — can cause withdrawal symptoms when it is cut off, Blankson said.“A couple sodas a day is even too much for the average kid,” he said.

A heart typically has about one to three irregular heart beats per minute. But a lot of caffeine can make the heart skip as many as six beats per minute. At the same time, it can increase blood pressure.Children have a lower tolerance for caffeine, which means they could experience ill effects sooner than adults typically would, and with lower amounts.Dr. Ihuoma Eneli, medical director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, said medications such as Ritalin already make the heart beat faster.Adding caffeine to the mix could put children at even greater risk, Eneli said.

Some students take Ritalin to help them study. And some use energy drinks to keep themselves awake.

Experts say the mixture is unwise.“Stimulants on stimulants do not result in more concentration,” said Dr. Steven Lipshultz, professor of pediatrics and director of the Batchelor Children’s Research Institute at the University of Miami’s Miller School of Medicine.

Death is rarely caused by energy drinks alone.Dr. Eric Adkins, an emergency-medicine physician at Ohio State University’s Wexner Medical Center, estimated that caffeine lingers in the body for five to eight hours.

He said most of the patients who do come into the emergency department with life-threatening conditions resulting from “caffeine toxicities” are teenagers who mix energy drinks with alcohol.

“What alcohol does is accelerate the effects of caffeine and block the awareness of alcohol. And that leads to more abuse,” said Dr. Kanny Grewal, a cardiologist and director of cardiac imaging at OhioHealth.

The U.S. Food and Drug Administration recognized the risk in mixing the two and banned alcohol from the popular caffeinated drink Four Loko in 2011, said Dr. Daniel Fabricant, director of the agency’s dietary-supplements programs.

Sara Jerde is a Scripps School of Journalism Ohio Statehouse Bureau Fellow.